Eating Disorders and Diabetes

A new study shows that more than half of young adults with Type 2 diabetes, and over 20% with Type 1, engage in behaviors that indicate eating disorders. They obsess about food; many come to see food as an enemy.

Does that resonate for you? Does having diabetes make eating a source of stress, not of sustenance or pleasure? This could be a problem.

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Disordered eating takes multiple recognized forms. According to blogger Martha Zimmer, these include:

Anorexia nervosa. An obsessive fear of weight gain that leads people (mostly women) to starve themselves.

Bulimia. Eating and then purging by throwing up or using laxatives.

Diabulimia. In people with Type 1 diabetes, skipping insulin to lose weight.

Binge eating. Compulsive eating, past the point of feeling full, usually done in secret.

Orthorexia. Obsession with eating healthy. This might mean cutting out large groups of foods and feeling constant guilt about what you eat.

All eating disorders involve obsession with food, how much and what to eat. Sounds to me like the kind of advice given to people with diabetes. Not only are people with diabetes told to eat in particular ways, but are nearly always told to lose weight.

“The way we explain [diabetes management] to kids and their parents now, with the focus and preoccupation with food choices and limiting what they eat, could actually make the patients prone to developing some inappropriate eating behaviors to lose weight,” said the study’s lead researcher Angel Siu Ying Nip, MD, of the University of Washington.

Notice that this “preoccupation with food choices and limiting” is taught to nearly all Americans, especially girls, from the time we’re children. Being thin is considered essential to being attractive, healthy, and successful. Girls often start dieting before they reach puberty.

Focus on diabetes amplifies the focus on thinness. “The obsession with eating right is often reinforced by doctors and our…media,” says Zimmer. “It is refueled every day by the billion-dollar diet industry that feeds on our fears.” The myth that fat causes diabetes creates even more stress around eating.

Eating disorders are no joke. In Dr. Nip’s study, those with disordered eating were more likely to be depressed and to score lower on quality-of-life measures. They had significantly more insulin resistance, higher body-mass index (BMI), and poorer diabetes control as indicated by higher HbA1c.

Diabulimia in young adults with Type 1 is particularly dangerous. Registered dietitian and certified diabetes educator Amy Campbell, MS, RD, LDN, CDE, reported here that, “Serious consequences can occur if insulin is omitted, such as diabetic ketoacidosis, dehydration, nausea, blurred vision, and a higher rate of diabetes complications.”

How eating disorders start
Eating disorders typically start with attempts to lose weight. Natalia Zunino, PhD, of the American Anorexia and Bulimia Association, Inc., says, “The most common behavior that will lead to an eating disorder is dieting.”

Since diets rarely produce sustained weight loss, people get caught in an endless cycle of diet, weight loss, regain, and diet again. Martha Zimmer says this cycle leads to guilt, frustration, self-loathing, and stress, which people may treat with food. “Girls who diet frequently are about 12 times more likely to binge eat,” she says.

Diabetes takes food stress to a whole new level. “Fear of dying from a complication of diabetes may be how it starts,” writes Zimmer. “A desire to feel better about yourself often leads to eating disorders like orthorexia. There can be a need to control something in your life, especially now that you have a chronic condition like diabetes.”

Of course, with diabetes, you need to eat right. But what is “right”? How obsessed do you have to be? Zimmer says feeling like you’re eating right “feels like a good thing at first. But self-punishment and constantly planning and worrying over what you will eat [and feeling guilty about what you ate] are signs you have gone too far.”

How ordered is your eating?
Subjects in Dr. Yip’s study answered questions on the Diabetes Eating Problem Survey-Revised (DEPS-R), agreeing or disagreeing with statements such as:

• Losing weight is an important goal to me
• I skip meals and/or snacks
• I eat more when I am alone than when I am with others
• I feel that it’s difficult to lose weight and control my diabetes at the same time
• I avoid checking my blood sugar when I feel like it is out of range
• I feel fat when I take all of my insulin
• Other people tell me to take better care of my diabetes
• I would rather be thin than to have good control of my diabetes

If you agreed with any of these statements, you might want to take the whole 16-question survey here (under the heading “Items retained in DEPS-R”).

If you agree with many statements on the DEPS-R, get help. Amy Campbell says, “If you think you have any type of eating disorder, let your health-care team know. It may seem easier to try and ignore or forget about it, but doing so can lead to very real and serious health issues.”

If you can resolve some of the stress about eating and weight, you will probably find your diabetes much easier to control. You will definitely find your life more enjoyable.

Want to learn more about diabetes and eating disorders? Read “Diabulimia,” “Help for Those Dealing With Diabulimia,” and “Diabetes and Eating Disorders.”